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Royal Sundaram Health Insurance

Earlier known as Royal Sundaram Alliance Insurance Co. Ltd., Royal Sundaram General Insurance Co. Ltd is recognized as one of the top general insurance companies in India. It offers comprehensive insurance plans with innovative features and solutions. A host of insurance products are offered by the company and Royal Sundaram health insurance is one of the most trusted products among others. Moreover, the company was awarded with ‘Celent Model Insurer Asia Award’ for its efficient claim management services in the year 2013 and 14.

Royal Sundaram Health Insurance at a Glance

Key Features Highlights
Incurred Claim Ratio 78.13%
Network Hospitals 3000+
No-claim-bonus Yes
Renewability Lifelong

Features of Royal Sundaram Health Insurance

The features of Royal Sundaram health insurance are mentioned below:

  • Up to a maximum of five family members can be covered.
  • Royal Sundaram offers lifelong renewability option.
  • Pre and post hospitalization expenses are covered for 30 days and 60 days respectively.
  • 147 daycare procedures are also covered
  • In case of an accidental hospitalization, you get an additional cover of 50% of the SI
  • Royal Sundaram mediclaim insurance plans also cover maternity expenses
  • Free health-check-up is provided on completion of 4 claim-free years and the limit is up to Rs. 750 per head.
  • You can avail a No Claim Bonus of 5% to 50% for each claim-free year
  • Pre-existing illness will be covered after 3 years of continuous policy renewal.

Royal Sundaram Health Insurance Plan Comparison Table

Plan Name Entry Age Sum Insured (in Rs.) Policy Period Maternity benefit Type of Coverage
Royal Sundaram Classic Lifeline Health Insurance Plan Adults: 18 years & above Children:  91 days to 25 years 2,00,000- 4,00,000 1, 2 or 3 years  

Not covered

Individual/Family Floater
Royal Sundaram Supreme Lifeline Health Insurance Plan Adults: 18 years & above Children:  91 days to 25 years 5,00,000, 10,00,000,  15, 00,000, 20,00,000, 50,00,000 1, 2 or 3 years  

Not covered

Individual/Family Floater
Royal Sundaram Elite Lifeline Health Insurance Adults: 18 years & above Children:  91 days to 25 years 25,00,000 to 1 cr.  

Up to 2 deliveries

Newborn baby care up to 25% of SI

Vaccinations for one year.

Royal Sundaram Family Plus Health Insurance Plan Adults: 18 years & above Children:  Above 91 days Individual Plans: Rs. 2 to 15 lakhs

Floater Plan: Rs.3 to 50 lakhs

Covered Family Floater

(up to 19 relationships)

Types of Royal Sundaram Health Insurance Plans

The various types of mediclaim plans offered by Royal Sundaram are:

  1. Royal Sundaram Lifeline Medical Insurance Plan– Lifeline is a complete medical insurance plan and it comes in 3 variants – Classic Plan, Supreme Plan, and Elite Plan. Choose a plan and get a health insurance quote to meet your unique needs. Anyone can buy this plan as there is no restriction on the maximum age.
  2. Family Plus Health Insurance Plan – It is a comprehensive medical insurance plan that is designed to cover a large family up to a maximum of 19 relations.

Royal Sundaram Health Insurance Claim Process

Royal Sundaram Health Insurance claim can be made in two ways:

  • Cashless Claim
  • Reimbursement Claim

The procedure for both is different. Let’s have a look

For claiming cashless benefit, the insured must avail the treatment from a network hospital only. Royal Sundaram health insurance hospital list is provided at the time of purchasing the policy. You need to fill an authorization form provided by the hospital authority or TPA and follow the given formalities in the prescribed form.

If it is a reimbursement claim, then the insurer has to be informed about the incident and provide the estimate of the expenses incurred. The insured needs to fill and submit a claim form along with the discharge summary, doctor’s prescription, and the medical bills.

Important details required for claim intimation are:

  • Royal Sundaram mediclaim policy number
  • Name of the hospital
  • Contact no., email id, residential address, landmark etc. of the policyholder/applicant
  • Name of the patient or insured who is admitted in the hospital
  • Relationship of policyholder with the patient
  • Nature of illness
  • In case of an accidental hospitalization, details of the accident, date, time, and location are required
  • Starting date of the symptoms of the illness

Step-Wise Cashless Claim Procedure

  • If the hospitalization was planned, you need to inform the TPA about it and get a cashless authorization in minimum 72 hours before hospitalization.
  • In case of an emergency, the TPA should be informed within 24 hours of the hospitalization.
  • Fill the cashless authorization form provided by the TPA. The TPA will first check the coverage and your eligibility to avail the claim.
  • Attach all the necessary documents along with the duly filled claim form and submit it to the TPA department. If there is any discrepancy, the TPA will coordinate with you within 4 hours of receiving the form.
  • Pay the expenses that are not covered in the Royal Sundaram health insurance plan
  • In case a specific ailment is not covered in this plan, a rejection letter will be issued to you within 2 hours.

Royal Sundaram Health Insurance Claim Procedure for Cashless Facility

  • In case of an emergency hospitalization overseas, inform the insurer within the 24 hours of the hospitalization.
  • The eligibility to file a claim would be verified by the company and you will receive a call from the insurer to initiate the claim.
  • If the pre-authorization request is approved, the hospital expenses will be directly compensated by the health insurance company.
  • And if there is an additional cost attached to it, it has to be borne by you.

Claim Procedure for Reimbursement

If the treatment was taken in a non-network hospital and you want to make a claim, then you need to follow these steps to file a claim-

  • Submit the duly filled and signed claim form within 30 days of discharge from the hospital
  • If the insurer finds everything appropriate, then the claim amount will be recompensed within 30 days of lodging the claim
  • In case of any discrepancy or rejection, a letter of rejection will be sent to you within 7 days of claim submission
  • The payment will be made in the name of applicant/proposer
  • All the documents need to be submitted at the branch office

Claim Procedure for International Treatment for 11 specified Critical Illnesses

Royal Sundaram health insurance also offers international treatment for some specified illnesses. Here is how to lodge claims under any such circumstances-

  • Immediately inform the insurer upon diagnosis of any specified critical illness. If you are planning to travel overseas, you need to inform the insurance company and request for a pre-authorization to avail the medical treatment abroad.
  • Depending on your eligibility the request will be processed
  • The insurer will coordinate with the hospital authorities to seek approval
  • If the pre-authorization request is approved, the expenses will be directly settled by Royal Sundaram.
  • You just need to pay the additional charges ( if any)
  • In case of emergency hospitalization, you need to inform Royal Sundaram within 24 hours of the admission. And if it is a planned hospitalization, the company should be informed within 48 hours prior to hospitalization.

Royal Sundaram Health Insurance Renewal

It is imperative that you renew your mediclaim policy before it is expired. The steps are elucidated below-

  1. Provide your health insurance policy number
  2. Expiry date
  3. Review the policy details
  4. Check the premium
  5. Pay online using a debit/credit card

Inclusions of Royal Sundaram Health Insurance Plans

  1. Fees charged by the medical practitioner
  2. Room rent charges
  3. Boarding expenses
  4. ICU charges
  5. Nursing Charges
  6. Diagnostics Procedures charges
  7. Medicines, drugs, and consumables
  8. Cost of Intravenous fluids, blood, surgical appliances, injection administration charges, oxygen, blood transfusion, and operation theatre charges
  9. The cost of devices and prosthetics if implanted internally during a surgery

Furthermore, you can opt for a host of additional coverage like-

  1. Organ donor expenses
  2. Pre-hospitalization medical expenses
  3. Daycare treatment
  4. Ayush treatment
  5. Post-hospitalization medical expenses
  6. Ambulance cover
  7. No Claim Bonus
  8. Domiciliary hospitalization
  9. Health checkup
  10. Restoration of sum insured
  11. Preventive healthcare & wellness
  12. Vaccination in case of an animal bite
  13. Emergency domestic evacuation
  14. Second opinion in case of critical illnesses
  15. Maternity benefits
  16. Nutritional Allowance for mother ( post-delivery)
  17. Global emergency hospitalization cover
  18. Worldwide treatment for 11 specified critical illnesses
  19. Newborn baby cover
  20. OPD Treatment
  21. Vaccination for New Born Baby

Exclusions of Royal Sundaram Health Insurance

Below mentioned illnesses/diseases are not covered under Royal Sundaram medical insurance plans-

  • Pre-existing diseases mentioned in the policy or those declared at the time of policy purchase shall be covered after completion of 2 consecutive policy years. Any break in between will make it inapplicable.
  • Any claim arising within the first 30 days of the policy inception date ( unless it is an accidental case)
  • Critical Illness treatment or diagnoses within the initial 90 days from the policy purchase date shall not be reimbursed
  • For the initial 48 months disease like Cataract, hip replacement surgery, renal failure, benign prostatic Hypertrophy shall not be covered

Permanent exclusions –

  • Alternative treatment other than Ayush treatment
  • Any occupationally related disease
  • Congenital health conditions
  • Treatment for HIV/AIDS infection
  • Self-inflicted injuries or mental disorders like depression and anxiety symptoms
  • Cosmetic and plastic surgeries
  • Observational hospitalization
  • Speech related disorders
  • Stem cell implantation
  • Sleep-related disorders
  • Treatment for Alopecia
  • Dental treatment
  • Treatment received outside India ( except for supreme plan)
  • Injury resulting from involvement in unlawful activities

Benefits of Royal Sundaram Health Insurance

The benefits of buying Royal Sundaram medical insurance are mentioned below:

  • Discount ranging from 7.5% or 12% on purchase of a long-term plan
  • Rather buy a separate health insurance plan for each individual in the family; you can opt for Royal Sundaram family health plan that offers coverage to a maximum of five members.
  • Avail cashless treatment in more than 3000 network hospitals across India.
  • Flexible payment option makes it easy for you to pay the premium through Net banking/Credit Card/Debit card etc.
  • Every claim-free year is rewarded with No-claim-bonus
  • The policyholder can avail tax benefit under Section 80C and 10D of Income Tax Act, against the health insurance paid.

Royal Sundaram Health Insurance Premium Calculation

The procedure to calculate the health insurance premium for Royal Sundaram medical insurance is simple and effective. Here is a quick rundown of the process that follows:

  • Select the calculate premium option
  • Select the plan type
  • Choose coverage type: Individual/family floater
  • Number of adults
  • Number of children
  • Select sum insured
  • Date of birth of the eldest member
  • Mobile number
  • Email id
  • Name of the proposer
  • Click on Calculate premium

To get an online quotation, you can select the ‘Get Quote’ option and by providing all the required information such as the type of coverage, mobile number, the number of adults and children to be covered.

Why Royal Sundaram Health Insurance?

Royal Sundaram medical insurance plans are designed to provide you with financial support in case of a medical emergency.

Royal Sundaram health insurance plans are available at an affordable cost with customizable sum insured options.  You can pick from a host of plans ranging from basic health insurance plans to specific plans providing maternity cover, No-claim-bonus and automatic restoration of the sum insured. You can opt for various add-on features to enhance your medical coverage.

The health insurance company’s claim settlement ratio also reflects positively. Moreover, it was one of the first general insurance companies to tie up with various banks to sell their insurance products.

Documents Required for Royal Sundaram Health Insurance Claims

Here is a list of documents that you need to furnish in order to lodge a claim with Royal Sundaram health insurance. For a detailed list please refer to the policy wordings.

  • Hospital bills/receipts/cash memos ( in original)
  • Reports of medical test/ doctor prescriptions/ medical consultations for related illness.
  • All reports related to the treatment such as ECG, MRI, X-rays, and Pathology etc.
  • Hospital discharge summary/ case history/ discharge and admission summary, reports of the treatment given, and medical advice issued by the hospital
  • In case of death submit the death summary issued by the hospital.

Royal Sundaram Health Insurance FAQs

Q1. How is the Royal Sundaram medical insurance premium calculated?

The insurer calculates the premium based on the policy tenure, the age of the policyholder, coverage type, sum insured opted, and the geographical location.

Q2. Is medical test mandatory to buy a Royal Sundaram mediclaim policy?

A medical test is required only for applicant above 45 years of age. However, a pre-medical screening will be required for member below 45 years in case of any pre-existing diseases.

Q3. What are the different types of Royal Sundaram Health Insurance plans?

There are two types of health insurance plans – Royal Sundaram Lifeline Health Plan and Royal Family Plus Plan.

  1. Royal Sundaram Lifeline Health Plan has three variants:
    • Lifeline Classic
    • Lifeline Supreme
    • Lifeline Elite

This is an individual plan as well as family  health insurance plan for joint families in India – providing health cover to you, your children and spouse. Because a healthy family is a happy family! 
2. Royal Sundaram Family Plus Plan offers coverage to 19 members in a single plan. The Sum assured options range from Rs. 2 lakhs to 50 lakhs.

Q4. What is the eligibility criterion to purchase Royal Sundaram Lifeline Health Plan?

The criterion to buy this plan is listed below-

  • Any individual whose age is more than 18 years can get insured under this plan
  • The plan will provide coverage to the applicant along with their spouse and dependent children starting from 91 days old to 25 years of age
  • There is no cap on maximum entry age

Q5. What are the special features of Royal Sundaram Lifeline Elite plan?

The features are listed below-

  • International treatment cover for 11 specified critical illnesses along with return flight cost to be reimbursed up to Rs.3 lakhs. This excludes cover in the US and Canada. This can be additionally covered at the time of policy purchase.
  • Second opinion for 11 major critical illnesses
  • Maternity cover
  • Double your sum insured ad no-claim bonus benefit after 5 years
  • Easy cancellation process